高通量透析的效果及对患者生存率的影响  

Effect of high-flux hemodialysis on survival rate in renal failure patients

作　　者：班遵浦[1] 罗国鸿[1] 陈彤[1] 

机构地区：[1]贵州省遵义市第一人民医院血液透析室,贵州遵义563002

出　　处：《中国现代医学杂志》2017年第11期125-128,共4页China Journal of Modern Medicine

摘　　要：目的探讨高通量透析对中分子物质的清除作用及透析患者死亡的相关因素。方法选取2015年6月-2016年1月在该院血液净化中心行血液透析的216例慢性肾衰竭(尿毒症)患者,根据透析方式将患者随机分为高通量透析组(HF,n=104)和低通量透析组(LF,n=112),检测治疗前后血清肌酐(Cr)、尿素氮(BUN)、β2微球蛋白(β2-MG)、免疫反应性甲状旁腺激素(iPTH)及C反应蛋白(CRP)浓度水平,卡普兰-迈耶(Kaplan-Meier)生存曲线分析两组患者生存率,COX多因素回归分析影响患者死亡的危险因素。结果透析后,两组血清Cr、BUN、β2-MG、iPTH及CRP浓度均降低,HF组血清Cr、BUN、β2-MG及iPTH浓度低于LF组,HF组临床症状改善多于LF组(χ~2=5.782,P=0.016)。LF组死亡率高于HF组(χ~2=4.202,P=0.040),HF组累积生存率高于LF组(P=0.011),COX多因素回归分析结果显示透析类型、心血管疾病、肾小球滤过率(GFR)、血清Cr及β2-MG水平是影响透析患者死亡的危险因素。结论高通量透析(HFHD)能有效清除尿毒症患者体内中分子毒素,改善临床症状,降低透析患者死亡率,改善预后。Objective To explore the effect of high-flux hemodialysis on middle molecular weight toxins, and to analyze the causes of death in patients. Methods A total of 216 cases of renal failure patients were randomly divided into two groups （HF, n = 104） and （LF, n = 112） in the First People＇s Hospital of Zunyi City. Levels of Cr, BUN, β2-MG, iPTH and CRP were detected before and after the treatment. Survival rate was analyzed by Kaplan-Meier survival curve, and risk factors were analyzed by multivariate cox regression analysis. Results After the treatment, serum levels of creatinine, BUN, β2-MG and iPTH were significantly decreased, and improvement of clinical symptoms in HF group was better than that in LF group （χ2= 5.782, P=0.016）. The mortality of LF group was significantly higher than that of HF group （χ2=4.202, P=0.040）, and cumulative survival rate of HF group was significantly higher than that of LF group （P= 0.011）. Dialysis type, cardiovascular disease, GFR, Cr and β2-MG were the risk factors. Conclusions High-flux hemodialysis can effectively clear middle molecular weight toxins, and improve clinical symptoms and prognosis.

关 键 词：高通量透析 中分子物质 预后 尿毒症 

分 类 号：R692.5[医药卫生—泌尿科学]